Assessment Test 5 Jarvis (Musculoskeletal, Neurological)
Crossed representation is
a feature of the nerve tracts; the left cerebral cortex receives sensory information from and controls motor function to the right side of body, whereas the right cerebral cortex likewise interacts with the left side of the body.
Superficial reflexes include
abdominal, cremasteric, and plantar (or Babinski) reflexes.
The ______ reflex is an example of a _________ reflex
abdominal; superficial
the peripheral nervous system includes
all the nerve fibers outside the brain and spinal cord
Crepitation is
an audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened.
During assessment of extraocular movements, two back-and-forth oscillations of the eyes in the extreme lateral gaze occurs. This response indicates:
an expected movement of the eyes during this procedure.
Absent pain sensation
analgesia
absent touch sensation
anesthesia
When testing for muscle strength, the examiner should:
apply an opposing force when the individual puts a joint in flexion or extension.
The lower motor neurons
are located mostly in the peripheral nervous system and extend from the spinal cord to the muscles; examples include the cranial nerves and spinal nerves.
upper motor neurons
are located within the central nervous system and influence or modify the lower motor neurons and include the corticospinal, corticobulbar, and extrapyramidal tracts.
The upper motor neurons
are located within the central nervous system; influence or modify the lower motor neurons; and include the corticospinal, corticobulbar, and extrapyramidal tracts.
Cerebellar function is tested by
balance tests (e.g., gait, Romberg test) and coordination and skilled movements (e.g., rapid alternating movements, finger-to-finger test, finger-to-nose test, heel-to-shin test).
The extrapyramidal system is located in the
basal ganglia
Cranial nerves enter and exit the what?
brain
the central nervous system include the
brain and and spinal cord
The _____________ coordinates movement, maintains equilibrium, and helps maintain posture.
cerebellum
Cranial nerves I and II extend from the
cerebrum
The divisions of the spinal vertebrae include:
cervical, thoracic, lumbar, sacral, and coccygeal.
medulla
contains all ascending and descending fiber tracts; it has vital autonomic centers for respiration, heart, and gastrointestinal function as well as nuclei for cranial nerves VIII through XII.
Scoliosis
curved spine
People start getting shorter because
cushioning deteriation
the cutaneous distribution of the various spinal nerves
dermal segmentation
The quadriceps reflex is
a deep tendon reflex and is normal.
Hallux valgus
a common deformity from rheumatoid arthritis. It is a lateral or outward deviation of the great toe with medial prominence of the head of the first metatarsal.
Fasciculation is
localized uncoordinated, uncontrollable twitching of a single muscle group innervated by a single motor nerve fiber or filament.
Cranial nerves III through XII extend from the
lower diencephalon and brainstem
The radius and ulna are bones in the
lower part of the upper extremity
lordosis
lower spin sucked in
Do males or females start shrinking earlier?
males
Efferent messages
messages FROM the CNS out to muscles and glands, as well as autonomic messages that govern the internal organs and blood vessels
Afferent messages
messages carried by the peripheral nervous system TO the the CNS from sensory receptors motors
The cerebellum controls
motor coordination of voluntary movements, equilibrium, and muscle tone.
The extrapyramidal system maintains
muscle tone and controls body movements, especially gross automatic movements such as walking.
What questions to ask for seizures
o Any things leading up to it (aura) ex: double vision, spinning o Does it happen suddenly or gradually o What happens after your seizure
Crepitation is an audible sound that is produced by:
roughened articular surfaces moving over each other.
Clonus that may be seen when testing deep tendon reflexes is characterized by a(n):
set of rapid, rhythmic contractions of the same muscle.
Tendons are
strong fibrous cords that attach skeletal muscles to bones.
Automatic associated movements of the body are under the control and regulation of:
the basal ganglia.
Dermal segmentation is
the cutaneous distribution of the various spinal nerves.
To assess for a spinal curvature
the examiner has the person bend over and touch the toes with the knee in extension.
The 12 pairs of cranial nerves supply primarily?
the head and neck, except the vagus nerve
What type of system is the corticospinal tract and what does it do?
the higher motor system that permits very skilled and purposeful movements such as writing.
Muscle strength assessment examines
the intactness of the motor system.
To assess range of motion of the leg
the leg should be abducted and adducted with the knee extended.
The spinal nerves arise from?
the length of the spinal cord
The corneal light reflex assesses
the parallel alignment of the eye (cranial nerves III, IV, and VI).
Deep tendon reflexes test
the reflex arc at the spinal level and include the biceps, triceps, brachioradialis, quadriceps, and Achilles.
The 31 spinal nerves supply?
the rest of the body
Vestibular function is
the sense of balance.
Superficial reflexes test
the sensory receptor in the skin; the motor response is a localized muscle contraction
The vagus nerve travels
to the heart, respiratory, muscles, stomach, and gallbladder
Osteoarthritis
• Bourchard nodes • Heberden nodes • DJD- degenerative joint disease • Cold rainy days, • Hurt in the afternoon • Rest helps these people • Fear of rheumatic fever
What causes gout?
• Caused by elevated uric acid • Diabetic/ kidney disease • Alcohol abuse
What are the four types of reflexes?
• Deep tendon reflexes ex: knee jerk • Superficial ex: corneal reflex • Visceral ex: pupillary response to light • Pathologic (abnormal) ex: Babinski's reflex or take something sharp start at heel and go up towards big toe and then to little know and hope no reflexes happen
Rheumatoid Arthritis
• Swan-neck, boutonniere • Effects the joints, very warm, red, and irritated, auto-immune, • hurt in the morning, (inherited) • Important to stay active • Weather effects
Where is gout usually found? What happens?
• Usually happens in thumbs and big toes (big joints) • Flare up feels very hot, red, inflamed
Rotator Cuff Tear
"haunched" position and limited abduction of arm. Occurs from traumatic adduction while arm is held in abductions, or from fall on shoulder, throwing, or heavy lifting.
Bunion
(hallux valgus) the inflamed bursa that forms at the pressure point
The peripheral nervous system has how many pairs of cranial nerves?
12
What is the normal score for a Glascow coma scale
15
The peripheral nervous system has how many pairs of spinal nerves
31
The peripheral nervous system has how many pairs total?
43
Humans have _ cervical, _ thoracic, _ lumbar, _ sacral, and _ to _ coccygeal vertebrae.
7, 12, 5, 5, and 3 to 4
Which of the following ethnic groups has the lowest incidence of osteoporosis?
African Americans
How do you test the spinothalamic tract for light touch?
Apply a wisp of cotton to the skin along the forearms, hands, chest, thighs, and legs and ask when the touch is felt
Romberg test
Ask person to stand up with feet together and arms at the sides. Once in a stable position, ask the person to close the eyes and to hold the position. Monitor posture and balance.
How do you test Cranial nerve V
Assess muscles of mastication by palpating the temporal and masseter muscles as the person clenches the teeth. With person's eyes closed, test light touch sensation by touching a cotton wisp to these designated areas on person's face: forehead, checks, and chin
Uncoordinated or unsteady gait
Ataxia
is an impaired ability to coordinate movement, often characterized by a staggering gait and postural imbalance.
Ataxia
What term is used to describe involuntary muscle movements?
Athetosis
is slow, writhing, continuous, and involuntary movements of the extremities.
Athetosis
The loss of muscle mass
Atrophy
osteophytes of the proximal interphalangeal joints are called
Bouchard nodes.
is an inflammation of the bursa.
Bursitis
The thumb, middle finger, and fifth finger are each in the dermatomes of
C6, C7, C8
How do you test Cranial nerve III, IV, VI
Check pupils for PERRLA- Pupils Equal Round Reactive to Light and Accommodation. Assess extra ocular movement by the 6 cardinal gazes Down and inward eye movement
How do you test Cranial nerve IX and X
Depress the tongue with a tongue blade, and pharyngeal movement as the person says "ahhh" or yawns; the uvula and soft palate should rise in the midline and the tonsillar pillars should move medially. Touch the posterior pharyngeal wall with a tongue blade, and note the gag reflex. Also not that the voice sounds smooth and not strained swallowing/ 1/3 taste on front of tongue
is weak, soft, and flabby; lacking normal muscle tone.
Flaccid
Osteophytes (bony overgrowths) of the distal interphalangeal joints are called
Heberden nodes
is blindness in half of the normal visual field.
Hemianopsia
is the breakdown of red blood cells.
Hemolysis
is coughing up blood from the respiratory system.
Hemoptysis
When would a patient be considered in a coma
If scoring 7 or lower
The groin is in the region of
L1
The knee is at the level of
L4
How do you test the Posterior column tract position (kinesthesia)?
Move a finger or the big toe up and down, and ask the person to tell you which way it is moved while the eyes are closed.
How do you test Cranial nerve VII
Note mobility and facial symmetry as the person responds to these requests: smile, frown, close eyes tightly (against your attempt to open them), lift eyebrows, show teeth, and puff cheeks. Then press the person's cheeks in, and note that the air should escape equally from both sides (smile and let me see your teeth or blow your cheeks and pop your balloon 2/3 tongue of back of tongue for taste)
How do you test Cranial nerve I
Occlude one nostril and place non-noxious smells near nostril for patient to identify
a loss of motor function as a result of a lesion in the neurologic or muscular system or loss of sensory innervation.
Paralysis
is a condition in which a person hears and comprehends words but is unable to speak correctly; incoherent words are substituted for intended words.
Paraphasia
is a partial or incomplete paralysis.
Paresis
Numbness or tinglin
Peresis
How do you test Cranial nerve VIII
Perform whisper test hearing (put hand over face and whisper 1,2,3 while holding hand over one ear (3 out of 6 without being sent)
How do you test the spinothalamic tract for temperature?
Place flat side of tuning fork on the skin and ask patient if it feels cool?
What questions do you ask for a patient in pain?
Provoke, quality, radiate, severity, time Onset of the event What the patient was doing when it started (active, inactive, stressed), whether the patient believes that activity prompted the pain,[1] and whether the onset was sudden, gradual or part of an ongoing chronic problem. Provocation or palliation Whether any movement, pressure (such as palpation) or other external factor makes the problem better or worse. This can also include whether the symptoms relieve with rest. Quality of the pain This is the patient's description of the pain. Questions can be open ended ("Can you describe it for me?") or leading.[8] Ideally, this will elicit descriptions of the patient's pain: whether it is sharp, dull, crushing, burning, tearing, or some other feeling, along with the pattern, such as intermittent, constant, or throbbing. Region and radiation Where the pain is on the body and whether it radiates (extends) or moves to any other area. This can give indications for conditions such as a myocardial infarction, which can radiate through the jaw and arms. Other referred pains can provide clues to underlying medical causes. Severity Time
How do you test the Posterior column tract for fine touch?
Sterognosis- With the person's eye closed, place a familiar object in his or her hand and ask the person to identify it. OR Graphesthesia- Trace a number on a patients hand and have them identify it without looking
The axilla is at the level of
T1
The umbilicus is at the level of
T10
The nipple is at the level of
T4
How do you test the cerebellar function?
Tandem walking, Romberg test, Rapid alternating movements, finger-to-finger test, finger-to-nose test, heel-to-shin test.
What three things does the Glascow coma scale test?
Test eye response, verbal response, motor response
How do you test the spinothalamic tract for pain?
Test pain by ability to perceive a pinprick. Break a tongue blade lengthwise, forming a sharp point at the fractured end and a dull spot at the round end. Lightly apply the sharp point or the dull end to the person's body in a random, unpredictable order and ask patient to identify the sensation felt
How do you test Cranial nerve II
Test visual acuity and test visual fields by confrontation. Using the ophthalmoscope , examine the ocular funds to determine the color size, and shape of the optic disc.
is a major respiratory center with basic vital functions: temperature, appetite, sex drive, heart rate, and blood pressure control; sleep center; anterior and posterior pituitary gland regulation; and coordination of autonomic nervous system activity and stress response.
The hypothalamus
What test reproduces back and leg pain and helps confirm the presence of a herniated nucleus pulpous.
The straight leg-raising (Lasègue) test
s where sensory pathways of the spinal cord, cerebellum, and brainstem form synapses on their way to the cerebral cortex.
The thalamus
True or False? The fibula is not involved in articulation of the knee joint.
True
How do you test the Posterior column tract for vibration?
Use a low pitch tuning fork by striking in with your heel or hand and placing in distal bony areas such as fingers and great toe. If sensation is felt, proximal locations can be assumed.
a circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerve
dermatome
An area of the body that is supplied mainly from one spinal segment through a particular spinal nerve is identified as a:
dermatome.
Dupuytren contracture occurs with
diabetes, epilepsy, and alcoholic liver disease.
Range of motion can be described by
estimating (or measuring) the degree of flexion and extension of a joint.
Superficial pain and touch assessment
examines intactness of the spinothalamic tract.
Bundles of muscle fibers that compose skeletal muscle are identified as:
fasciculi.
The knee joint is the articulation of which three bones?
femur, tibia, and patella.
Ligaments are
fibrous bands running directly from one bone to another.
Chronic hyperplasia of the palmar fascia causes
flexion contractures of the digits.
What causes atrophy
from disuse, muscle tissue damage, or motor nerve damage
Osteoarthritis is characterized by
hard, nontender nodules, 2 to 3 mm or more in size.
How do you test Cranial nerve XI
have patient shrug their shoulders up and down or move their face towards resistance
How do you test Cranial nerve XII
have patient stick out tongue and move back and forth
The production of red blood cells in the bone marrow is called:
hematopoiesis.
Each half of the cerebrum is a
hemisphere.
kyphosis
hunched back
increased pain sensation
hyperalgesia
increased touch sensation
hyperesthesia
Decreased pain sensation
hypoalgesia
decreased touch sensation
hypoesthesia
The presence of primitive reflexes in a newborn infant is indicative of
immaturity of the nervous system.
Muscle extension can be assessed by
instructing the person to rise from a squatting position without using the hands for support.
What is Nystagmus
is a back-and-forth oscillation of the eyes.
What is hypertrophy?
is an increase in muscle mass due to an increase in muscle cell size.
Wernicke's area in the temporal lobe
is associated with language comprehension.
the olecranon process
is located on the proximal end of the ulna.
What questions to ask? PQRST for a headache
o If it's the worst headache they've ever had get to ER for CT scan o Head injuries? Had loss of consciousness? For how long? o Numbess or tingling (paresis) o Loss of sensation (neuropathy) How long have they had it? How does it effect them? Do they take any thing for it?
Effects of aging on the neurological system?
o Slower reflexes o Impaired gait (ataxia- unsteady gait) o Pupils respond slower
lower motor neurons
ocated mostly in the peripheral nervous system and extend from the spinal cord to the muscles; examples include the cranial nerves and spinal nerves.
Heberden and Bouchard nodes are hard and nontender and are associated with:
osteoarthritis
Spinothalamic tract is sensations of?
pain, temp, and crude or light touch
An abnormal sensation of burning or tingling is best described as
paresthesia
Cerebellar function is tested by:
performance of rapid alternating movements.
Posterior columns is sensations of?
position, vibration, and finely localized touch
The functions of the musculoskeletal system include:
protection and storage.
The functions of the musculoskeletal system are as follows:
provide support to stand erect; allow movement; encase and protect the inner vital organs; produce the red blood cells in the bone marrow; and act as a reservoir for storage of essential minerals, such as calcium and phosphorus in the bones.
When assessing for the presence of a herniated nucleus pulposus, the examiner would:
raise each of the patient's legs straight while keeping the knee extended.
Testing the deep tendon reflexes gives the examiner information regarding the intactness of the:
reflex arc at specific levels in the spinal cord.
What are the basic defense mechanisms of nervous system
reflexes
The Phalen test
reproduces numbness and burning in a patient with carpal tunnel syndrome.
Swan neck, boutonnière deformity, and ulnar deviation are conditions associated with
rheumatoid arthritis.